Abstract: Smart Sensor Bandage for Ulcer Monitoring Non-healing pressure ulcers result in approximately $10 billion in additional treatments each year in the United States, raising in-hospital mortality by nearly threefold and lengthening hospital stay by more than double when ulcers are present. This burden is particularly pronounced in assisted living facilities where occurrence is high and skilled nursing care is required once an ulcer develops. Current clinical practice employs few effective practices and tools for prevention of ulcer development. Most often care professionals visually inspect the immobilized patient's skin and better-equipped facilities may use pressure sensors. However, none of these methods can detect ulcers before they form. To address this need, S&A Technologies, a biotechnology startup founded in 2016, has collaborated with biomedical engineers at Missouri University of Science and Technology to develop the first smart sensor bandage capable of detecting ulcer formation before skin decomposition occurs. The smart bandage functions by detecting low oxygen tension caused by compromised circulation in high-risk skin regions and features connectivity with portable devices to enable remote monitoring. The overall objective of the proposed research is to develop a smart bandage prototype capable of detecting the formation of pressure ulcers in high-risk patients. First, we will optimize the composition and fabrication of the sensor array by embedding sensors and reference luminophores in a flexible matrix polymer using inexpensive inkjet printing techniques. Next, we will develop a user-friendly smartphone with focusing attachment that will provide constant focal length and minimal ambient light interference. This prototype will be first evaluated in vitro using a tissue phantom platform that mimics an incipient wound. We will then evaluate the prototype in normal human subjects with cuff-induced forearm ischemia and in immobile patients at high risk for developing pressure ulcers. The proposed research will provide basic proof-of-concept for our smart sensor bandage technology that will enable us to develop fully functional remote sensing app technology in a planned Phase II STTR proposal. This technology will also provide clinicians with a new platform to study the basic etiology of chronic ulcers, which has not been previously possible, and may contribute to the development of new interventions to lower the incidence of ulceration and monitoring healing when it occurs. Finally, our interdisciplinary research team involves collaboration between privately held S&A Technologies and Missouri University of Science and Technology located in rural Missouri. The team features multidisciplinary expertise, including an electrical engineer specializing in sensor fabrication, a clinical dermatologist with extensive experience in wound care management and bandage development, and a wound care specialist with experience in developing novel pressure ulcer treatments that uniquely enables it to perform the proposed research. This team builds upon several existing collaborations between S&A Technologies and Missouri S&T.